Abstract 1456 Neonatal Epidemiology and Follow-up Poster Symposium, Monday, 5/3

BACKGROUND: Although there is anecdotal evidence that there are variations in treatment decisions for infants at the limit of viability in NICUs, there is little documented evidence of this variation or of whether these decisions are associated with differences in outcomes.

METHOD: We examined the outcomes of all deliveries ≥22 weeks gestation in 12 hospitals participating in the Canadian NICU Network which had inborn deliveries during Jan 1996 to Oct 1997. All were tertiary referral perinatal centers. For all babies between 22 and 25 weeks gestation, we recorded numbers of babies delivered by gestation, delivery room deaths, inborn and outborn admission to the NICU, and deaths in the NICU. We also examined morbidity outcomes (IVH, BPD, NEC) and illness severity and correlated them with delivery room deaths.

RESULTS: There was significant variation in delivery room deaths (8.5%-57.4%). The survival rate of inborn patients (22-25 weeks) ranged from 31.8% to 78.6%. There was a direct correlation between rate of delivery room deaths and mortality rate in the NICU (0.669, p<0.035). There was no significant relationship between delivery room death and morbidity (IVH, BPD, NEC). There was no significant relationship between delivery room deaths and illness severity (SNAPII).

CONCLUSIONS: Significant variation in delivery room deaths and survival rates among NICUs of marginally viable infants may be due to differences in treatment decisions. If so, such treatment decisions do not appear to impact on the rates of NICU morbidities such as IVH, BPD and NEC, or on the admission illness severity of the infants.

Funded by the Medical Research Council of Canada